The 7th Health Insurance Policy Deliberation Committee Meeting Held
'NH투자증권' Health Insurance Coverage... Out-of-Pocket Cost 83 Million KRW → 4.17 Million KRW
The government will provide an additional 188.2 billion KRW in health insurance funds to support emergency medical services and prevent gaps in care for severe patients due to doctors' collective actions.
On the 28th, the Ministry of Health and Welfare held the 7th Health Insurance Policy Deliberation Committee meeting and approved ▲ revisions to the drug benefit list and benefit ceiling price table ▲ extension of health insurance emergency medical support measures ▲ conversion of blood viscosity tests to non-benefit under selective benefit appropriateness evaluation.
They also discussed ▲ expanding benefits for assistive devices for children with severe disabilities (establishing standing training devices) ▲ expanding the pilot project for children's dental primary care under health insurance.
At the meeting, the Ministry decided to extend the support period for temporary additional fees for mild patient referrals and enhanced compensation for emergency and severe inpatient care to prevent care gaps caused by prolonged emergency medical services. Following last month, the Ministry will inject 188.2 billion KRW of health insurance funds again this month.
First, to allow emergency rooms and tertiary hospitals to focus on emergency and severe patient care, compensation will be strengthened when mild patients are referred from tertiary hospitals to clinics or hospitals. To enable rapid response to critical and emergency patients within hospitals, a new policy support fund will be established for specialists such as professors when treating critical and inpatient cases.
Additionally, during the emergency medical period, to maintain a care system centered on severe patients at tertiary hospitals and other medical institutions, post-compensation will be promoted for institutions actively providing care.
Following this Health Insurance Policy Deliberation Committee decision, from next month, the reimbursement ceiling for the breast and stomach cancer treatment drug "Enhertu (generic name: trastuzumab deruxtecan)" by Korea Daiichi Sankyo will be set at 1,431,000 KRW, and health insurance coverage will be newly applied.
Patients with HER-positive metastatic breast cancer previously bore an annual medication cost of 83 million KRW per person, but with this health insurance coverage, they will pay 4.17 million KRW (applying 5% co-payment).
The health insurance coverage is set for metastatic breast and stomach cancers that are HER2-positive with prior treatment experience.
The Ministry of Health and Welfare announced plans to expand health insurance coverage for the approved drugs from the 1st of next month by revising the "Drug Benefit List and Benefit Ceiling Price Table" notice.
Alongside this, to promote growth and development and improve treatment and health for children with severe disabilities, insurance benefits will be newly established for standing training devices, assistive devices for standing posture training.
The support target is individuals aged 18 or younger with severe brain lesions or physical disabilities who have difficulty standing independently and cannot maintain an independent standing posture. The benefit standard amount and durability for the standing training device will be set at 2.2 million KRW and 3 years, respectively, considering current product status and standards from other assistive device support projects for disabled persons.
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